Farm to Treatment Table, Inc

Primary specialty

Physical TherapistTaxonomy code 225100000X

Legal business name

FARM TO TREATMENT TABLE, INC

Practice address

5354 W 25TH Ave
Edgewater, CO 80214-1244

Phone

(303) 931-6478

NPI assigned

Aug 1, 2017

Last updated

Jul 21, 2022By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Becky Kellogg, MS PT

Title

Owner/President

Phone

(303) 931-6478

Specialties & licenses 2

Addresses

Other names 1

• Farm to Treatment Table, LLC Former legal business name

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1501545600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658361600000",
    "number": "1861916827",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5354 W 25TH AVE",
            "city": "EDGEWATER",
            "state": "CO",
            "postal_code": "802141244",
            "telephone_number": "303-931-6478"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5354 W 25TH AVE",
            "city": "EDGEWATER",
            "state": "CO",
            "postal_code": "802141244",
            "telephone_number": "303-931-6478"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FARM TO TREATMENT TABLE, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-08-01",
        "last_updated": "2022-07-21",
        "certification_date": "2020-02-03",
        "status": "A",
        "authorized_official_last_name": "KELLOGG",
        "authorized_official_first_name": "BECKY",
        "authorized_official_title_or_position": "OWNER/PRESIDENT",
        "authorized_official_telephone_number": "303-931-6478",
        "authorized_official_credential": "MS PT"
    },
    "taxonomies": [
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Farm to Treatment Table, LLC",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

• Emil Dezia, PHARM.D.
• Michael Diaz, PHARMD
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• Casey Elizabeth Dunne
• Edgewater Modern Dentistry and Orthodontics, LLP (Edgewater Modern Dentistry and Orthodontics)
• Lawrence Farmer Jr.
• Adam Jeffrey Gentry, DDS
• William Caleb Gillum, DDS
• Madeleine Glodowski
• Sydney Hecht, BSN, RN

• Physical Therapist in Edgewater, CO
• Providers in Edgewater, CO by specialty
• Physical Therapist in Colorado

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.